Food Choices and NCDs

By Sanju Prasad

While there is a proven link between non-communicable diseases and poverty, this doesn’t necessarily mean those on the margins of society are destined to contract NCDs even though they might be at a greater risk. It’s a matter of what you choose to eat and drink, says a doctor.

National adviser for non-communicable diseases Doctor Isimeli Tukana said NCDs was a choice issue, adding that regardless of the socioeconomic status, everybody needed to eat and drink.

“Everybody will eat no matter poor or rich.

Dr Isimeli Tukana (NCDs National Advisor Ministry of Health)

“But there is another argument. Because unhealthy food is cheaper, poor people normally choose that because healthier choices are a bit expensive,” Dr Tukana said.

According to a paper compiled by The World Bank titled “Health & non-communicable diseases”, because high-fat, lower-fibre foods were usually cheaper than healthier alternatives, poorer people were generally more constrained to purchase low-cost food.

This has resulted in poverty and the low-income segment of the population falling into the NCD trap, thus giving birth to a cycle where poverty leads to higher prevalence and more severe NCDs.

Dr Tukana said as the national adviser NCDs, he was in talks with the Government to create an environment where healthier choices such as fruits and vegetables were made affordable to Fijians living in poverty.

“So poverty is a real issue, but how do we work in that space? Do we give them more money? Do we give them more food? Or do we give them seedlings to plant? So that’s the kind of argument we are making to the Government,” he said.

Dr Tukana, however, said Fiji was not lacking food.

“We have so much food, but it’s just a matter of choice. We have forgotten how to eat it. We have to teach people again how to enjoy the plenty food we have,” he said.

This, he said, went back to parenting and nurturing and how a child was brought up.

“One big example is why children were eating noodles. It was because we taught them to. If you teach them to eat rourou (spinach), they would most probably continue eating rourou, but the thing is some of them have never eaten rourou when they were young so they run away when they see rourou.

“It’s the parenting and nurturing mind-set that needs to change as well,” Dr Tukana said.

He said because adults were not setting examples of healthy eating habits, it was hard for children to follow.

This, he said, resulted in only 15 per cent of Fijians eating enough fruits and vegetables, of which most were Indians of Fijian descent.

Premila Kumar (Consumer Council of Fiji chief executive officer)

Consumer Council of Fiji chief executive officer Premila Kumar, while reiterating that NCDs was a question of choice, said Fiji had an abundance of land and it was a matter of people taking initiative and growing their own vegies.

“So we can’t just say people are in poverty and they can’t afford healthy food, it’s the choices they are making.

“Even your own kids, if you are going to put chicken and chips and very healthy food in front of them, which one will they pick?

“It’s a question of choice and I think here regarding NCDs, it’s all about how do we change the behaviour of people so that they realise the value of healthy choices,” Ms Kumar said.

She said health was a subject that was not taken seriously unless one fell sick.

A report collated by the Secretariat of the Pacific Community titled “NCD Statistics for the Pacific Islands Countries and Territories” (2005-2010) revealed that in Fiji, 22 per cent of males between 25 and 64 years old were suffering from hypertension. This was equivalent to one in every five men. While 23 per cent of females between the same age group also suffered from hypertension.

As for diabetes, 13 per cent of males between 25 and 64 years old suffered from diabetes in Fiji, while 16 per cent of females in the same age group also had diabetes.

“When you end up with diabetes, blood pressure or cancer and any of those nasty diseases, that’s when realisation comes in, but that’s when it’s too late,” Ms Kumar said.

She added that even with less money, one could plan a healthy meal.

“I know I lot of people want to say that the cost of living has gone up, but if you really think about it and the way people are spending, where is all the money coming from?

NCD project officer with the Ministry of Health Andrew Prasad, while admitting there was a link between NCDs and poverty, said through his personal experience with the project, when you compare people from different social economic income brackets, there were those who could afford healthy choices as well as those whose choices were limited because of their earning power.

“In terms of healthy choices, our people who do not have that much earnings tend to invest in very cheap food, which may not be a healthy choice,” Prasad said.

He said NGOs, the World Health Organization, the Agriculture Ministry, and the Food and Agriculture Organization that run food security programs should come up with proactive strategies that were tailor-made for people living in very low social economic bracket.

“We can’t stop people from eating processed food because that’s not going to happen. So we need to change the strategy a bit, encourage them to prepare healthy meals with processed food like grilling sausages instead of frying in oil and taking the oil out of tuna cans before using them.”

While efforts were being made by the Health Ministry to encourage healthy eating habits, Dr Tukana said they were urging Government to increase tax on sugary goods and processed food every year, but the problem was even the impoverished ones were hooked into these things and if they continued to buy them, it would drive them more into poverty.

“It has its pros and cons, even now when kava is around $100 a kg, people still buy it because they are addicted, so really it’s about choices,” Dr Tukana said.

Dr Tukana said with every plate; half should be filled with fruits and vegetables. At the moment it was not happening and this needed to be taught and should be a conscious choice.